NSG 3100 Exam 4: 50 Questions with 100% Correct
Answers | Galen College (2026/2027 Edition)
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1.
A 68-year-old patient with a history of chronic heart failure (HFrEF) presents to the
emergency department with worsening dyspnea, jugular venous distension, and 3+
pitting edema in the lower extremities. The patient's current medications include
lisinopril, metoprolol succinate, furosemide, and dapagliflozin. The provider orders an IV
bolus of furosemide 80 mg. Which assessment finding during the diuretic phase most
accurately indicates to the nurse that the patient's preload reduction is occurring as
intended?
A. Decrease in blood pressure from 158/92 mmHg to 110/68 mmHg within 30 minutes
B. Reduction in respiratory rate from 28 to 18 breaths per minute and diminished
crackles on auscultation
C. Increase in urine specific gravity from 1.010 to 1.030 within the first hour
D. Development of orthostatic hypotension when transitioning from supine to standing
position
Correct Answer: B. Reduction in respiratory rate from 28 to 18 breaths per minute and
diminished crackles on auscultation
Rationale: In acute decompensated heart failure, the primary therapeutic goal of loop
diuretic therapy is to reduce pulmonary congestion and improve oxygenation. A
reduction in respiratory rate and diminished crackles indicate successful mobilization of
interstitial and alveolar fluid, reflecting decreased pulmonary venous pressure. While
blood pressure changes (Option A) may occur, a precipitous drop suggests excessive
afterload reduction or hypovolemia rather than optimal preload management. Increased
,urine specific gravity (Option C) indicates concentrated urine, which is inconsistent with
the expected dilute, high-volume diuresis following furosemide administration.
Orthostatic hypotension (Option D) represents an adverse effect of excessive volume
depletion and requires intervention, not continuation of the current therapy.
Question 2.
A patient with atrial fibrillation newly prescribed apixaban 5 mg twice daily asks the
nurse why this medication was chosen over warfarin. The nurse's response should be
based on which 2026 clinical advantage?
A. Apixaban requires less frequent renal function monitoring than warfarin requires INR
monitoring
B. Apixaban has a specific reversal agent that can be administered orally in the
outpatient setting
C. Apixaban demonstrates superior efficacy in patients with mechanical heart valves
compared to warfarin
D. Apixaban has fewer drug-food interactions and does not require routine coagulation
monitoring
Correct Answer: D. Apixaban has fewer drug-food interactions and does not require
routine coagulation monitoring
Rationale: Direct oral anticoagulants (DOACs) such as apixaban offer a significant
advantage over warfarin by eliminating the need for routine INR monitoring and dietary
vitamin K restrictions. Current 2026 AHA/ACC/HRS guidelines continue to recommend
DOACs as first-line therapy for nonvalvular atrial fibrillation stroke prevention. While
apixaban does have a specific reversal agent (andexanet alfa), it is administered
intravenously in acute settings, not orally (Option B is incorrect). DOACs are
contraindicated in patients with mechanical heart valves (Option C is incorrect).
Although apixaban requires less frequent monitoring than warfarin, renal function must
,still be assessed periodically, particularly in older adults (Option A is partially true but
not the primary clinical advantage).
Question 3.
During the insertion of a pulmonary artery catheter, the nurse observes the waveform
transition from a right atrial pressure tracing to a pulmonary artery pressure tracing.
Suddenly, the patient develops a new onset of dysrhythmia. Which immediate nursing
action is the priority?
A. Administer a bolus of normal saline through the distal port to stabilize the catheter
position
B. Deflate the balloon immediately and notify the provider while preparing for possible
arrhythmia management
C. Advance the catheter an additional 2 to 3 cm to obtain a wedged waveform for
diagnostic confirmation
D. Document the finding and continue to monitor the patient for 15 minutes before
intervening
Correct Answer: B. Deflate the balloon immediately and notify the provider while
preparing for possible arrhythmia management
Rationale: The transition from an RA to PA waveform without an intervening RV
waveform suggests the catheter may have advanced directly through the right atrium
into the pulmonary artery, or more critically, the balloon may be inflated during passage
through the right ventricle, causing mechanical irritation and ventricular ectopy. The
immediate priority is to deflate the balloon to reduce myocardial irritation and prevent
potential perforation or sustained arrhythmia. Advancing the catheter further (Option C)
or delaying intervention (Option D) could precipitate life-threatening ventricular
tachycardia or fibrillation. A saline bolus (Option A) does not address the mechanical
cause of the arrhythmia.
, Question 4.
A patient with hypertrophic cardiomyopathy (HCM) is being prepared for discharge.
Which instruction should the nurse prioritize to reduce the patient's risk of sudden
cardiac death?
A. Maintain adequate hydration and avoid strenuous physical activity until cleared by
cardiology
B. Begin a low-intensity aerobic exercise program within two weeks of discharge to
improve cardiac output
C. Take the prescribed beta-blocker only when experiencing palpitations or chest
discomfort
D. Use over-the-counter decongestants containing pseudoephedrine for cold symptom
management
Correct Answer: A. Maintain adequate hydration and avoid strenuous physical activity
until cleared by cardiology
Rationale: In hypertrophic cardiomyopathy, dehydration and strenuous exercise increase
the risk of dynamic left ventricular outflow tract obstruction, which can precipitate
syncope, arrhythmias, and sudden cardiac death. Current 2026 AHA/ACC guidelines
emphasize hydration maintenance and activity restriction pending comprehensive risk
stratification. Beta-blockers (Option C) must be taken consistently, not PRN, to maintain
reduced contractility and heart rate. Decongestants containing pseudoephedrine
(Option D) are contraindicated due to their vasoconstrictive and chronotropic effects.
Early strenuous exercise (Option B) is contraindicated in HCM.
Question 5.
A patient in cardiogenic shock has the following hemodynamic parameters: MAP 58
mmHg, CVP 14 mmHg, PAOP 24 mmHg, and cardiac index 1.8 L/min/m². The provider
orders dobutamine 5 mcg/kg/min IV infusion. Which assessment finding indicates to
the nurse that the dobutamine infusion is producing the desired therapeutic effect?
Answers | Galen College (2026/2027 Edition)
SECTION 1: CARDIOVASCULAR DISORDERS
Question 1.
A 68-year-old patient with a history of chronic heart failure (HFrEF) presents to the
emergency department with worsening dyspnea, jugular venous distension, and 3+
pitting edema in the lower extremities. The patient's current medications include
lisinopril, metoprolol succinate, furosemide, and dapagliflozin. The provider orders an IV
bolus of furosemide 80 mg. Which assessment finding during the diuretic phase most
accurately indicates to the nurse that the patient's preload reduction is occurring as
intended?
A. Decrease in blood pressure from 158/92 mmHg to 110/68 mmHg within 30 minutes
B. Reduction in respiratory rate from 28 to 18 breaths per minute and diminished
crackles on auscultation
C. Increase in urine specific gravity from 1.010 to 1.030 within the first hour
D. Development of orthostatic hypotension when transitioning from supine to standing
position
Correct Answer: B. Reduction in respiratory rate from 28 to 18 breaths per minute and
diminished crackles on auscultation
Rationale: In acute decompensated heart failure, the primary therapeutic goal of loop
diuretic therapy is to reduce pulmonary congestion and improve oxygenation. A
reduction in respiratory rate and diminished crackles indicate successful mobilization of
interstitial and alveolar fluid, reflecting decreased pulmonary venous pressure. While
blood pressure changes (Option A) may occur, a precipitous drop suggests excessive
afterload reduction or hypovolemia rather than optimal preload management. Increased
,urine specific gravity (Option C) indicates concentrated urine, which is inconsistent with
the expected dilute, high-volume diuresis following furosemide administration.
Orthostatic hypotension (Option D) represents an adverse effect of excessive volume
depletion and requires intervention, not continuation of the current therapy.
Question 2.
A patient with atrial fibrillation newly prescribed apixaban 5 mg twice daily asks the
nurse why this medication was chosen over warfarin. The nurse's response should be
based on which 2026 clinical advantage?
A. Apixaban requires less frequent renal function monitoring than warfarin requires INR
monitoring
B. Apixaban has a specific reversal agent that can be administered orally in the
outpatient setting
C. Apixaban demonstrates superior efficacy in patients with mechanical heart valves
compared to warfarin
D. Apixaban has fewer drug-food interactions and does not require routine coagulation
monitoring
Correct Answer: D. Apixaban has fewer drug-food interactions and does not require
routine coagulation monitoring
Rationale: Direct oral anticoagulants (DOACs) such as apixaban offer a significant
advantage over warfarin by eliminating the need for routine INR monitoring and dietary
vitamin K restrictions. Current 2026 AHA/ACC/HRS guidelines continue to recommend
DOACs as first-line therapy for nonvalvular atrial fibrillation stroke prevention. While
apixaban does have a specific reversal agent (andexanet alfa), it is administered
intravenously in acute settings, not orally (Option B is incorrect). DOACs are
contraindicated in patients with mechanical heart valves (Option C is incorrect).
Although apixaban requires less frequent monitoring than warfarin, renal function must
,still be assessed periodically, particularly in older adults (Option A is partially true but
not the primary clinical advantage).
Question 3.
During the insertion of a pulmonary artery catheter, the nurse observes the waveform
transition from a right atrial pressure tracing to a pulmonary artery pressure tracing.
Suddenly, the patient develops a new onset of dysrhythmia. Which immediate nursing
action is the priority?
A. Administer a bolus of normal saline through the distal port to stabilize the catheter
position
B. Deflate the balloon immediately and notify the provider while preparing for possible
arrhythmia management
C. Advance the catheter an additional 2 to 3 cm to obtain a wedged waveform for
diagnostic confirmation
D. Document the finding and continue to monitor the patient for 15 minutes before
intervening
Correct Answer: B. Deflate the balloon immediately and notify the provider while
preparing for possible arrhythmia management
Rationale: The transition from an RA to PA waveform without an intervening RV
waveform suggests the catheter may have advanced directly through the right atrium
into the pulmonary artery, or more critically, the balloon may be inflated during passage
through the right ventricle, causing mechanical irritation and ventricular ectopy. The
immediate priority is to deflate the balloon to reduce myocardial irritation and prevent
potential perforation or sustained arrhythmia. Advancing the catheter further (Option C)
or delaying intervention (Option D) could precipitate life-threatening ventricular
tachycardia or fibrillation. A saline bolus (Option A) does not address the mechanical
cause of the arrhythmia.
, Question 4.
A patient with hypertrophic cardiomyopathy (HCM) is being prepared for discharge.
Which instruction should the nurse prioritize to reduce the patient's risk of sudden
cardiac death?
A. Maintain adequate hydration and avoid strenuous physical activity until cleared by
cardiology
B. Begin a low-intensity aerobic exercise program within two weeks of discharge to
improve cardiac output
C. Take the prescribed beta-blocker only when experiencing palpitations or chest
discomfort
D. Use over-the-counter decongestants containing pseudoephedrine for cold symptom
management
Correct Answer: A. Maintain adequate hydration and avoid strenuous physical activity
until cleared by cardiology
Rationale: In hypertrophic cardiomyopathy, dehydration and strenuous exercise increase
the risk of dynamic left ventricular outflow tract obstruction, which can precipitate
syncope, arrhythmias, and sudden cardiac death. Current 2026 AHA/ACC guidelines
emphasize hydration maintenance and activity restriction pending comprehensive risk
stratification. Beta-blockers (Option C) must be taken consistently, not PRN, to maintain
reduced contractility and heart rate. Decongestants containing pseudoephedrine
(Option D) are contraindicated due to their vasoconstrictive and chronotropic effects.
Early strenuous exercise (Option B) is contraindicated in HCM.
Question 5.
A patient in cardiogenic shock has the following hemodynamic parameters: MAP 58
mmHg, CVP 14 mmHg, PAOP 24 mmHg, and cardiac index 1.8 L/min/m². The provider
orders dobutamine 5 mcg/kg/min IV infusion. Which assessment finding indicates to
the nurse that the dobutamine infusion is producing the desired therapeutic effect?
